Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA.
Radiology. 2012 Apr;263(1):243-52. doi: 10.1148/radiol.12110227.
A diagnostic radiology value chain is constructed to define its main components, all of which are vulnerable to change, because digitization has caused disaggregation of the chain. Some components afford opportunities to improve productivity, some add value, while some face outsourcing to lower labor cost and to information technology substitutes, raising commoditization risks. Digital image information, because it can be competitive at smaller economies of scale, allows faster, differential rates of technological innovation of components, initiating a centralization-to-decentralization technology trend. Digitization, having triggered disaggregation of radiology's professional service model, may soon usher in an information business model. This means moving from a mind-set of "reading images" to an orientation of creating and organizing information for greater accuracy, faster speed, and lower cost in medical decision making. Information businesses view value chain investments differently than do small professional services. In the former model, producing a better business product will extend image interpretation beyond a radiologist's personal fund of knowledge to encompass expanding external imaging databases. A follow-on expansion with integration of image and molecular information into a report will offer new value in medical decision making. Improved interpretation plus new integration will enrich and diversify radiology's key service products, the report and consultation. A more robust, information-rich report derived from a "systems" and "computational" radiology approach will be facilitated by a transition from a professional service to an information business. Under health care reform, radiology will transition its emphasis from volume to greater value. Radiology's future brightens with the adoption of a philosophy of offering information rather than "reads" for decision making. Staunchly defending the status quo via turf wars is unlikely to constitute a forward-looking, competitive strategy.
构建诊断放射学价值链，以定义其主要组成部分，所有这些组成部分都容易发生变化，因为数字化导致了价值链的解体。一些组成部分提供了提高生产力的机会，一些增加了价值，而另一些则面临着外包以降低劳动力成本和信息技术替代的风险，从而增加了商品化的风险。数字图像信息由于其在较小的规模经济下具有竞争力，因此允许更快、差异化的技术创新，从而引发了集中化到分散化的技术趋势。数字化引发了放射科专业服务模式的解体，可能很快就会迎来信息商业模式。这意味着从“阅读图像”的思维模式转变为创建和组织信息的方向，以提高医学决策的准确性、速度和降低成本。信息企业对价值链投资的看法与小型专业服务企业不同。在前者的模式中，生产更好的商业产品将扩展放射科医生个人知识库的范围，包括扩展外部成像数据库的图像解释。通过将图像和分子信息集成到报告中，后续的扩展将为医学决策提供新的价值。改进的解释加上新的集成将丰富和多样化放射科的主要服务产品，即报告和咨询。从专业服务向信息业务的转变将有助于从“系统”和“计算”放射学方法中获得更强大、信息更丰富的报告。在医疗改革下，放射科将从关注数量转变为更加注重价值。放射科采用提供信息而不是“阅读”来做出决策的理念，未来将更加光明。通过争夺地盘来坚决捍卫现状，不太可能构成具有前瞻性、竞争力的战略。
